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Introduction: Thyroid nodules are extremely common and require complex management to prevent unnecessary surgical intervention and ensure that no malignant disease is overlooked. Several diagnostic tools and scoring systems are available to evaluate the risk of malignancy (ROM). The goal is to assess variables that can aid and support the clinical recommendations suggested by the updated Bethesda System for Reporting Thyroid Cytopathology (TBSRTC-2023), such as the ultrasonographic features of thyroid nodules, particularly for the indeterminate categories III (atypia of undetermined significance) and IV (follicular neoplasm). Methods: We retrospectively analysed the correlation of the demographic and ultrasonographic characteristics of thyroid nodules with the cytopathological and histopathological diagnoses of TBSRTC categories III (atypia of undetermined significance), IV (follicular neoplasm), V (suspicious for malignancy), and VI (malignant) in patients who underwent surgery in a single Portuguese centre over a 10-year period. Results: In total, 360 nodules were evaluated in 341 patients, and 57% were histopathologically malignant or borderline. The majority were included in the TBSRTC indeterminate categories III and IV, with ROMs of 44% and 43%, respectively. The ultrasonographic characteristics associated with a higher TBSRTC category and a greater ROM value were hypoechogenicity, the presence of microcalcifications, irregular margins, and the presence of cervical adenopathy. When correlating with a malignant histology, only adenopathy and the presence of microcalcifications were observed to be statistically significant. Discussion: The indeterminate categories of the TBSRTC have been the most challenging ones to manage. The new TBSRTC (2023) guidelines, as well as the ultrasonographic characteristics of a patient’s nodule, can be helpful in assessing the ROM and deciding on an appropriate course of treatment. Other resources, such as molecular tests, are also playing a more important role in the clinical decision process and may become crucial in the future. Conclusions: The worrisome ultrasound features that this study found to statistically correlate with a malignant histology were the presence of microcalcifications and adenopathy. The clinical management of thyroid nodules requires a careful analysis of clinical history and an evaluation of demographic details, personal and family history, ultrasonographic features, and the results of cytopathology, thyroid function, and molecular/genetic tests.

Scientific evidence on loneliness shows that this feeling can act as a decisive negative factor in maintaining health. In this sense, an editorial on the subject stated that the damage to health is clear and associated loneliness with an increased risk of cardiovascular diseases, hypertension, diabetes, infectious diseases, impaired cognitive function, depression and anxiety. The editorial also highlighted that this is an issue that requires society's attention and, as a result, a committee was created to study loneliness and social isolation.(1) Due to the evidence of the harm it can cause or worsen, loneliness has become one of the major health concerns in the 21st century. As a result, initiatives have been developed and the governments of the United Kingdom and Japan created Ministries of Loneliness in 2018 and 2021, respectively.(2) Also, a health authority in the United States showed the consequences of insufficient connection for physical health and highlighted a 29% higher risk of heart disease, a 32% higher occurrence of stroke and a 50% higher chance of developing dementia in older people. In addition, it estimated that the lack of social connection increases the risk of premature death by more than 60%.(3) . . .

Biliary injury secondary to trauma is frequently associated with long-term complications. Liver transplantation is rarely indicated but might be the best therapeutic option in severe or intractable cases. We report the case of a 19-year-old male referred for liver transplantation due to biliary injury after abdominal trauma. A Roux-en-Y hepaticojejunostomy was initially performed without immediate complications. Anastomotic stricture developed requiring several trials of biliary dilatation and stenting through a percutaneous approach. The presence of liver cirrhosis and the intractability of this complication culminated in the decision of liver transplantation. The authors present clinical course, complications and interventional procedures that were used in a judicious step-up approach.

Digital banking services are embedded in people's daily lives. Despite this, these services are not accessible to everyone for various reasons, especially for people with low literacy. The objective of this work was to develop a method of accessibility inspection in mobile banking and banking chatbots, and the examination was directed toward the public mentioned before. For this reason, two inspection sequences were carried out on five Brazilian banking applications, mediated by accessibility considerations based on literature and case studies applied in the contexts of a riverside community and around elderly people with less experience in digital technology, as well as the mapping of design considerations with the Brazilian technical standard aimed at mobile applications and the investigation of banking chatbots made available by these applications. The results found in the inspections indicate how much the design considerations are satisfied, not satisfied and partially satisfied in the inspected applications and the comparison of the two inspections carried out. Additionally, it was possible to review and evaluate design considerations and propose improvements aimed at professionals who intend to develop accessible mobile bankings, as well as the importance of making banking chatbots.

ABSTRACT INTRODUCTION Lung cancer (LC) is a relevant public health problem in Brazil and worldwide, given its high incidence and mortality. Thus, the objective of this study is to analyze the distribution of smoking and smoking status according to sociodemographic characteristics and disparities in access, treatment, and mortality due to LC in Brazil in 2013 and 2019. METHOD Retrospective study of triangulation of national data sources: a) analysis of the distribution of smoking, based on the National Survey of Health (PNS); b) investigation of LC records via Hospital-based Cancer Registry (HCR); and c) distribution of mortality due to LC in the Mortality Information System (SIM). RESULTS There was a decrease in the percentage of people who had never smoked from 2013 (68.5%) to 2019 (60.2%) and in smoking history (pack-years). This was observed to be greater in men, people of older age groups, and those with less education. Concerning patients registered in the HCR, entry into the healthcare service occurs at the age of 50, and only 19% have never smoked. While smokers in the population are mainly Mixed-race, patients in the HCR are primarily White. As for the initial stage (I and II), it is more common in White people and people who have never smoked. The mortality rate varied from 1.00 for people with higher education to 3.36 for people without education. Furthermore, White people have a mortality rate three times higher than that of Black and mixed-race people. CONCLUSION This article highlighted relevant sociodemographic disparities in access to LC diagnosis, treatment, and mortality. Therefore, the recommendation is to strengthen the Population-Based Cancer Registry and develop and implement a nationwide LC screening strategy in Brazil since combined prevention and early diagnosis strategies work better in controlling mortality from the disease and continued investment in tobacco prevention and control policies.

Objectives: To verify the analytical performance of the HepatoPredict kit, a novel tool developed to stratify Hepatocellular Carcinoma (HCC) patients according to their risk of relapse after a Liver Transplantation (LT). Methods: The HepatoPredict tool combines clinical variables and a gene expression signature in an ensemble of machine-learning algorithms to forecast the benefit of a LT in HCC patients. To ensure the accuracy and reliability of this method, extensive analytical validation was conducted to verify its specificity and robustness. The experiments were designed following the guidelines for multi-target genomic assays such as ISO201395-2019, MIQE, CLSI-MM16, CLSI-MM17, and CLSI-EP17-A. The validation process included reproducibility between operators and between RNA extractions and RT-qPCR runs, and interference of input RNA levels or varying reagent levels. A recently retrained version of the HepatoPredict algorithms was also tested. Results: The validation process demonstrated that the HepatoPredict kit met the required standards for robustness (p > 0.05), analytical specificity (inclusivity of 95 %), and sensitivity (LoB, LoD, linear range, and amplification efficiency between 90 and 110 %). The operator, equipment, input RNA, and reagents used had no significant effect on the HepatoPredict results. Additionally, the testing of a recently retrained version of the HepatoPredict algorithm, showed that this new version further improved the accuracy of the kit and performed better than existing clinical criteria in accurately identifying HCC patients who are more likely to benefit LT. Conclusions: Even with the introduced variations in molecular and clinical variables, the HepatoPredict kit's prognostic information remains consistent. It can accurately identify HCC patients who are more likely to benefit from a LT. Its robust performance also confirms that it can be easily integrated into standard diagnostic laboratories.

Background: Lysosomal acid lipase deficiency (LAL-D) is a rare genetic disease associated with the deregulation of lipid metabolism, leading to atherosclerosis, dyslipidemia, and hepatic steatosis, with potential progression to cirrhosis. Our study aims to assess the role of LAL-D in the setting of cryptogenic liver disease. Methods: A large multicenter cross-sectional study was conducted, which included 135 patients with cryptogenic liver disease from four liver centers in Brazil. All patients were submitted to the investigation of LAL enzyme activity on dried blood spots. Results: Three patients (two female) presented levels of LAL below the reference limit, compatible with LAL-D (2.2%). They had a mean age of 43.9 ± 10.1 years and a mean body-mass index (BMI) of 23.1 ± 1.7 kg/m2. The mean serum levels of glucose, HDL-cholesterol, and triglycerides were 89.7 ± 3.2, 21.7 ± 3.2, and 206.7 ± 25.5 mg/dL, respectively. All patients had duodenal polyposis with xanthomatous macrophages. LAL-D investigation should be considered for individuals with chronic liver disease of an unknown etiology, especially with a normal BMI, high triglycerides, and low-HDL-cholesterol levels. The identification of LAL-D patients is extremely important since enzyme replacement therapy with Sebelipase Alfa significantly increases their survival.

Abstract Background Refractory benign esophageal strictures (RBESs) have been treated with the temporary placement of different self-expanding stents with conflicting results. We compared the clinical effectiveness of 3 types of stents: self-expanding plastic stents (SEPSs), biodegradable stents, and fully covered self-expanding metal stents (FCSEMSs), for the treatment of RBES. Methods This study prospectively evaluated 3 groups of 30 consecutive patients with RBESs who underwent temporary placement of either SEPSs (12 weeks, n = 10), biodegradable stents (n = 10) or FCSEMSs (12 weeks, n = 10). Data were collected to analyze the technical success and clinical outcome of the stents as evaluated by recurrent dysphagia, complications and reinterventions. Results Stent implantation was technically successful in all patients. Migration occurred in 11 patients: 6 (60%) in the SEPS group, 2 (20%) in the biodegradable group and 3 (30%) in the FCSEMS group (P = 0.16). A total of 8/30 patients (26.6%) were dysphagia-free after the end of follow-up: 1 (10%) in the SEPS group, 3 (30%) in the biodegradable group and 4 (40%) in the FCSEMS group (P = 0.27). More reinterventions were required in the SEPS group (n = 24) than in the biodegradable group (n = 13) or the FCSEMS group (n = 13) (P = 0.24). Multivariate analysis showed that stricture length was significantly associated with higher recurrence rates after temporary stent placement (HR = 1.37; 95% CI = 1.08-1.75; P = 0.011). Conclusions Temporary placement of a biodegradable stent or of a FCSEMS in patients with RBES may lead to long-term relief of dysphagia in 30 and 40% of patients, respectively. The use of SEPSs seems least preferable, as they are associated with frequent stent migration, more reinterventions and few cases of long-term improvement. Additionally, longer strictures were associated with a higher risk of recurrence.

Gastric ectopic pancreas (EP) is an uncommon congenital anomaly in which pancreatic tissue with no anatomic connection to the main pancreas is found in the stomach. Gastric EP is often discovered incidentally when a nonspecific submucosal tumor is found in endoscopic studies or other imaging examinations. Tissue characterization by biopsy or fine-needle aspiration is required as endoscopic findings alone cannot exclude malignancy. The authors present 2 cases of gastric EP incidentally detected on endoscopy, which underwent further characterization by magnetic resonance imaging (MRI). In both cases, MRI showed submucosal gastric lesions, isointense to the orthotopic pancreas in all sequences, including hyperintensity on T1-weighted images. Furthermore, the lesions showed bright arterial phase enhancement, paralleling the native pancreas. MRI may provide the best non-invasive imaging method for evaluating gastric submucosal lesions. This report intends to show that EP shows a characteristic MR appearance that allows differentiation from other submucosal lesions.

ABSTRACT Purpose To analyze the effect of communication training developed for adolescents on the youth’s communication skills. Methods Forty-one young people participated in the study and were divided into two groups. Group I received intervention - communication training for five weeks; Group II - were guided on the importance of voice for communication. Participants had their communication skills assessed before/after interventions through a self-administered questionnaire, answered by the participant and parents. Both groups had oral presentations recorded on video, which were analyzed by speech therapists through the evaluation of the communication profile, listing the aspects that should be observed as a point of strength/opportunity for improvement. Association between qualitative variables was assessed using Fischer’s exact test, Pearson’s chi-square test, McNemar’s test, and McNemar-Bowker’s test. To compare groups, paired t-test and t-test for independent samples, p level

Background: Listing patients with alcohol-associated liver disease (ALD) for liver transplant (LT) remains challenging especially due to the risk of alcohol resumption post-LT. We aimed to evaluate post-LT alcohol consumption at a Portuguese transplant center. Methods: We conducted a cross-sectional study including LT recipients from 2019 at Curry Cabral Hospital, Lisbon, Portugal. A pretested survey and a validated Portuguese translation of the Alcohol Use Disorder Identification Test (AUDIT) were applied via a telephone call. Alcohol consumption was defined by patients’ self-reports or a positive AUDIT. Results: In 2019, 122 patients underwent LT, and 99 patients answered the survey (June 2021). The mean (SD) age was 57 (10) years, 70 patients (70.7%) were males, and 49 (49.5%) underwent ALD-related LT. During a median (IQR) follow-up of 24 (20–26) months post-index LT, 22 (22.2%) recipients consumed any amount of alcohol: 14 had a drink monthly or less and 8 drank 2–4 times/month. On drinking days, 18 patients usually consumed 1–2 drinks and the remainder no more than 3–4 drinks. One patient reported having drunk ≥6 drinks on one occasion. All post-LT drinking recipients were considered low risk (score

Abstract Objective Diabetic foot infection (DFI) represents a major healthcare burden, for which treatment is challenging owing to the pathophysiological alterations intrinsic to diabetes and the alarming increase of antimicrobial resistance. Novel therapies targeting DFI are therefore a pressing research need for which proper models of disease are required. Results Here, we present an optimized diabetic mouse model of methicillin-resistant Staphylococcus aureus (MRSA)-infected wounds, that resemble key features of DFI, such as pathogen invasion through wound bed and surrounding tissue, necrosis, persistent inflammation and impaired wound healing. Thus, in a time-efficient manner and using simple techniques, this model represents a suitable approach for studying emerging therapies targeting DFI caused by MRSA.

Resumo Objetivo Construir e validar uma história em quadrinhos para adolescentes sobre reanimação cardíaca. Métodos Estudo metodológico de abordagem quantitativa realizado em três fases: 1) revisão integrativa, 2) identificação das necessidades de aprendizagem (mediante inquérito transversal com 84 adolescentes) e 3) construção e validação de storyboard feito sob considerações da Teoria da Aprendizagem Significativa. A história obedeceu aos seis passos do quadrinista Mccloud, e foi validada por 23 juízes que julgaram os quadrinhos pelo Instrumento de Validação de Conteúdo Educacional em Saúde. Utilizou-se o Índice de Validade de Conteúdo e o Teste Binomial para verificar se a proporção de concordância foi, estatisticamente, igual ou superior a 80%. Resultados A revisão integrativa justificou ser necessária a construção de tecnologias educacionais sobre Suporte Básico de Vida. Os 84 adolescentes apontaram necessidade de aprendizagem sobre os três primeiros elos de atendimento a uma parada cardíaca. A tecnologia trouxe, na narrativa da personagem Dara, instruções para aplicar Suporte Básico de Vida somente com as mãos em vítimas de Parada Cardíaca. Na validação, 17 (dezessete) dos 18 (dezoito) itens avaliados receberam nota máxima, a avaliação global da tecnologia obteve o valor 0,99. Conclusão Os juízes consideraram válida a tecnologia educacional do tipo história em quadrinhos para ensinar reanimação cardiopulmonar.

ABSTRACT Studies related to climate change and agricultural value chains have in common the growing concern on conserving water resources. Thus, the concept of the water footprint stands out, which measures the amount of water (in volume) necessary to produce a unit (in mass) of a given product. Among Brazilian agricultural activities, coffee farming emerges as one of the most important, even though the crop is sensitive to potential climatic changes, especially to the increase in temperature and periods of drought. An alternative to mitigate the effects of climate change is shade management, which is common in agroforestry systems. Therefore, the objective of this study was to evaluate the influence of shade management on the water footprint of coffee activity in the region of “Matas de Minas”. The water footprint was calculated for the field and product processing phase. Despite reducing the evapotranspiration of the coffee plant, shade management provided an increase in the water footprint, since it decreased the crop yield. The water footprint data obtained are expressive, with a calculated value of 13,862 m3 t-1 for full sun management and 16,895 m3 t-1 for shade management, in which both are the most recommended for the agricultural sector.

Abstract Diabetic foot infection (DFI) is an important cause of morbidity and mortality. Antibiotics are fundamental for treating DFI, although bacterial biofilm formation and associated pathophysiology can reduce their effectiveness. Additionally, antibiotics are often associated with adverse reactions. Hence, improved antibiotic therapies are required for safer and effective DFI management. On this regard, drug delivery systems (DDSs) constitute a promising strategy. We propose a gellan gum (GG)‐based spongy‐like hydrogel as a topical and controlled DDS of vancomycin and clindamycin, for an improved dual antibiotic therapy against methicillin‐resistant Staphylococcus aureus (MRSA) in DFI. The developed DDS presents suitable features for topical application, while promoting the controlled release of both antibiotics, resulting in a significant reduction of in vitro antibiotic‐associated cytotoxicity without compromising antibacterial activity. The therapeutic potential of this DDS was further corroborated in vivo, in a diabetic mouse model of MRSA‐infected wounds. A single DDS administration allowed a significant bacterial burden reduction in a short period of time, without exacerbating host inflammatory response. Taken together, these results suggest that the proposed DDS represents a promising strategy for the topical treatment of DFI, potentially overcoming limitations associated with systemic antibiotic administration and minimizing the frequency of administration.

Introdução: Um grande desafio para a utilização de registros e bases de dados secundárias é a qualidade do registro e o percentual de perdas em variáveis estratégicas e necessárias à plena utilização do banco. Objetivo: Propor um método de correção para a variável de estadiamento no âmbito dos Registro Hospitalares de Câncer (RHC), a fim de aprimorar sua completude e qualidade. Método: Estudo descritivo, abrangendo as Unidades da Federação, utilizando-se como fonte de informação o RHC, de janeiro de 2013 a dezembro de 2019. O câncer de pulmão foi escolhido como caso para a correção do banco, em razão da sua alta taxa de mortalidade no Brasil e no mundo. As análises foram realizadas com o software de análises estatísticas SAS Studio e a base de dados organizada em Excel®. Resultados: O total de casos registrados no RHC foi de 86.026, e a variável de interesse, o estadiamento, teve um total de 32,0% de perda. Ao final de todas as etapas de correção, a perda foi de 9,8%, correspondendo a 22,2% de recuperação. Conclusão: A metodologia proposta representa um avanço na correção do banco do RHC, possibilitando a utilização dos dados de base secundária, com melhor representatividade das diferentes Regiões do país, sobre o tratamento de câncer de pulmão, com possibilidade de expansão de seu uso para outras topografias.

Introduction and Objectives: Metabolic dysfunction is influenced by several factors in patients with traumatic spinal cord injury (SCI), such as physical inactivity, modification in body mass distribution, reduction of androgenic hormones, modification in intestinal microbiota, and neuro-autonomic dysfunction itself. This study aimed to determine the prevalence of MAFLD and the independent factors associated with liver steatosis in patients with traumatic SCI. Materials and Methods: Patients with SCI hospitalized for rehabilitation were randomly assigned to participate. Blood samples were collected, and an abdominal ultrasound was performed. Exclusion criteria were non-traumatic spinal cord injury, less than one year since the injury and less than 18 years old. Patients answered a questionnaire about alcohol drinking and tobacco smoking, as well as a physical activity score. Student´s t-test or Mann Whitney test was used to compare groups (fatty liver and non-fatty liver). The chi-square test or Fisher's exact test was used to test the homogeneity between the proportions. Variables with p< 0.10 in the simple regression analysis were selected and the multiple logistic regression model was done. The significance level used for the tests was 5%. Results: Two hundred and twenty-five individuals were included initially, but 30 patients were excluded according to exclusion criteria. The mean age was 37 years and 82,6% were men. The prevalence of MAFLD was 17,4% in this population. Multiple logistic regression model showed that age (OR: 1,06 CI 1,03 – 1,09), body mass index (BMI) (OR: 1,21 CI 1,1 – 1,34), AST (OR: 1,07 CI 1,02 – 1,12), and HDL (OR: 0,942 CI 0,90 -0,98) were independent predictors of fatty liver in this population. Conclusions: The prevalence of MAFLD in traumatic spinal cord injured patients was not higher than in the general population. Age, BMI, AST and HDL were predictors of fatty liver. This population will have better long-term survival once we better understand metabolic dysfunction.

Introduction and Objectives: Cryptogenic chronic hepatitis is an increasing cause of liver transplantation and affects 5-15% of patients with chronic liver diseases. This study aimed to investigate possible underlying causes of presumed cryptogenic liver disease referred to specialized liver centers by general practitioners in Brazil and to propose a new diagnostic algorithm including metabolic-dysfunction-associated fatty liver disease (MAFLD) definition and lysosomal acid lipase deficiency (LAL-D) investigation. Materials and Methods: A retrospective multicentric Brazilian cohort of patients with presumed chronic cryptogenic hepatitis was reanalyzed with respect to their clinical, laboratory and histological data using Czaja´s algorithm (2011). Results: 326 patients [mean age 60 (46-68) years, 42.9% males] were initially included, 35.7% with cirrhosis. Forty-five individuals were excluded due to an incomplete etiological investigation. Using Czaja´s algorithm, diagnosis of nonalcoholic fatty liver disease could be established in 60 patients (21.3%), alpha-1-antitrypsin deficiency in 9 (3.2%), alcoholic liver disease in 7 (2.7%), autoimmune hepatitis in 5 (1.78%), hemochromatosis in 5 (1.78%), biliary-related hepatitis in 4 (1.4%), viral hepatitis in 4 (1.4%), Budd Chiari in 4 (1.4%), glycogenosis in 3 (1%), drug-induced liver injury in 2 (0.7%), and Wilson disease in 1 (0.35%). LAL-D was demonstrated in 3 individuals (1%). One hundred seventy-five patients remained with cryptogenic hepatitis (53.6%) (FIGURE A). During follow-up, 40 of those patients were submitted to liver transplantation and 19 (47.5%) were retrospectively diagnosed with non-alcoholic steatohepatitis after histopathological examination of the explanted liver. By including MAFLD in the first step of the new algorithm, 100 patients would have been diagnosed (34.9%), reducing the number of individuals without a diagnosis by 18.3% (FIGURE B). Conclusions: One-third of patients with initially presumed cryptogenic liver disease were diagnosed with MAFLD. Despite being a rare disease, LAL-D investigation should be considered for individuals with chronic liver disease of unknown etiology. An updated diagnostic algorithm is proposed for those individuals.

Introduction: Anastomotic leak (AL) is a dangerous complication in the early postoperative period after total gastrectomy or esophagectomy being associated with high mortality. Self-expandable metal stents (SEMS) play a significant role in AL management. Only one case report described the use of Mega-Stent in AL setting. The authors report a two-case series with different applications of a Niti-S esophageal Mega-Stent in AL management. Case Report: Case 1 is a 67-year-old male who underwent an esophagectomy due to a squamous cell carcinoma of the distal esophagus. The early postoperative period was complicated with AL and gastropleural fistula. Initially, an OTSC was deployed in the dehiscence but failed to resolve AL. The esophageal Mega-Stent was further placed in-between the esophagus and the bulbus. Post-stenting contrast studies confirmed no further AL.Case 2 is an 86-year-old woman who underwent total gastrectomy with roux-en-y esophagojejunostomy due to a gastric adenocarcinoma, complicated with AL. A partially covered metal stent (PCMS) was placed to cover the anastomosis. Computed tomography confirmed leakage persistence and a second PCMS was deployed, resolving the AL. Several weeks later, both PCMSs presented ingrowth from granulation tissue. An esophageal Mega-Stent was placed (stent-in-stent technique) and 2 weeks later, all stents were removed, with no AL recurrence. Discussion/Conclusion: SEMS placement for AL is a safe, well-established therapeutic technique. Limitations include stent migration and incomplete cover of large AL. Mega-Stent can be an emerging tool for endoscopic AL management.

Doenças parasitárias são bastante frequentes na clínica médica veterinária e algumas são consideradas importantes zoonoses. O objetivo dessa pesquisa foi comparar três metodologias coproparasitológicas, para determinar a eficiência das diferentes técnicas em relação à identificação de ovos de helmintos e cistos e oocistos de protozoários. Para tal foram utilizados os resultados de 108 amostras de fezes de animais as quais foram submetidas à Técnica de Ovos por Grama (OPG), Técnica de Centrífugo Flutuação em Açúcar (CFA) e a Técnica de Sheather Modificada. A carga parasitária das amostras, foi classificada com base nos resultados da Técnica de OPG. Foram calculados a frequência dos animais parasitados em relação às três metodologias e os resultados obtidos nas duas técnicas que obtiveram melhor desempenho, Técnicas de CFA e Sheather Modificada, foram submetidos ao teste de Qui-Quadrado e aos cálculos de sensibilidade, especificidade e acurácia. Todas as técnicas mostraram-se eficientes para o diagnóstico de diferentes formas parasitárias, no entanto, a Técnica de CFA foi a metodologia que apresentou os melhores resultados.

Pancreatic cancer is a devastating disease that has a grim prognosis, highlighting the need for improved screening, diagnosis, and treatment strategies. Currently, the sole biomarker for pancreatic ductal adenocarcinoma (PDAC) authorized by the U.S. Food and Drug Administration is CA 19-9, which proves to be the most beneficial in tracking treatment response rather than in early detection. In recent years, proteomics has emerged as a powerful tool for advancing our understanding of pancreatic cancer biology and identifying potential biomarkers and therapeutic targets. This review aims to offer a comprehensive survey of proteomics’ current status in pancreatic cancer research, specifically accentuating its applications and its potential to drastically enhance screening, diagnosis, and treatment response. With respect to screening and diagnostic precision, proteomics carries the capacity to augment the sensitivity and specificity of extant screening and diagnostic methodologies. Nonetheless, more research is imperative for validating potential biomarkers and establishing standard procedures for sample preparation and data analysis. Furthermore, proteomics presents opportunities for unveiling new biomarkers and therapeutic targets, as well as fostering the development of personalized treatment strategies based on protein expression patterns associated with treatment response. In conclusion, proteomics holds great promise for advancing our understanding of pancreatic cancer biology and improving patient outcomes. It is essential to maintain momentum in investment and innovation in this arena to unearth more groundbreaking discoveries and transmute them into practical diagnostic and therapeutic strategies in the clinical context.

Introduction: Although hyperferritinemia may reflect the inflammatory status of patients with non-alcoholic fatty liver disease (NAFLD), approximately 33% of hyperferritinemia cases reflect real hepatic iron overload. Aim: To evaluate a non-invasive method for assessing mild iron overload in patients with NAFLD using 3T magnetic resonance imaging (MRI) relaxometry, serum hepcidin, and the expression of ferritin subunits. Methods: This cross-sectional study assessed patients with biopsy-proven NAFLD. MRI relaxometry was performed using a 3T scanner in all patients, and the results were compared with iron content determined by liver biopsy. Ferritin, hepcidin, and ferritin subunits were assessed and classified according to ferritin levels and to siderosis identified by liver biopsy. Results: A total of 67 patients with NAFLD were included in the study. MRI revealed mild iron overload in all patients (sensitivity, 73.5%; specificity, 70%). For mild (grade 1) siderosis, the transverse relaxation rate (R2*) threshold was 58.9 s−1 and the mean value was 72.5 s−1 (SD, 33.9), while for grades 2/3 it was 88.2 s−1 (SD, 31.9) (p 30.2 ng/mL (sensitivity, 87%; specificity, 82%). Ferritin H and ferritin L subunits were expressed similarly in patients with NAFLD, regardless of siderosis. There were no significant differences in laboratory test results between the groups, including glucose parameters and liver function tests. Conclusions: MRI relaxometry and serum hepcidin accurately assessed mild iron overload in patients with dysmetabolic iron overload syndrome.

Little described in donkeys and of rare occurrence, fibrosarcoma is a malignant tumor of connective tissue. In this report, a 4-year-old donkey of the Pêga breed, used as a breeder, was referred to the Veterinary Hospital with a pendulum neoformation in the prepuce, according to owner with 1 month of evolution. Clinically, the animal was painfull and unconfortable when the tumor was manipulated, and the wound was ulcerated and with a focus of myiasis. An excisional biopsy was performed, and the mass was referred for histopathological examination, where the diagnosis of fibrosarcoma was obtained. Clinical aspects, diagnostic method and histopathological findings will be discussed in this case report.

Non-alcoholic fatty liver disease (NAFLD) currently represents an epidemic worldwide. NAFLD is the most frequently diagnosed chronic liver disease, affecting 20–30% of the general population. Furthermore, its prevalence is predicted to increase exponentially in the next decades, concomitantly with the global epidemic of obesity, type 2 diabetes mellitus (T2DM), and sedentary lifestyle. NAFLD is a clinical syndrome that encompasses a wide spectrum of associated diseases and hepatic complications such as hepatocellular carcinoma (HCC). Moreover, this disease is believed to become the main indication for liver transplantation in the near future. Since NAFLD management represents a growing challenge for primary care physicians, the Asociación Latinoamericana para el Estudio del Hígado (ALEH) has decided to organize this Practice Guidance for the Diagnosis and Treatment of Non-Alcoholic Fatty Liver Disease, written by Latin-American specialists in different clinical areas, and destined to general practitioners, internal medicine specialists, endocrinologists, diabetologists, gastroenterologists, and hepatologists. The main purpose of this document is to improve patient care and awareness of NAFLD. The information provided in this guidance may also be useful in assisting stakeholders in the decision-making process related to NAFLD. Since new evidence is constantly emerging on different aspects of the disease, updates to this guideline will be required in future.

The coffee leaf miner (Leucoptera coffeella) is a key coffee pest in Brazil that can cause severe defoliation and a negative impact on the productivity. Thus, it is essential to identify initial pest infestation for the sake of appropriate time control to avoid further economic damage to the coffee crops. A fast non-destructive method is an important tool that can be used to monitor the occurrence of the coffee leaf miner. The present work aims to identify the occurrence of coffee leaf miner infestation through a new vegetation index, using multispectral images from the Sentinel-2 satellite and the Google Earth Engine platform. Coffee leaf miner infestation was measured in the field in four cities in the state of Minas Gerais. The largest infestations occurred in September, October, and November but particularly in October 2021, in which the rate of infestation reached 85%, followed by September 2020 with a maximum infestation of 76%. The calculation steps of the vegetation indices and mappings were carried out in the Google Earth Engine cloud processing platform through the development of a script in JavaScript programming language. Combinations of two sensitive bands were selected to detect coffee leaf miner infestation, and from these, the “Coffee-Leaf-Miner Index” was developed, which was compared with other existing vegetation indices in terms of their performance for coffee leaf miner detection. The combination of the NIR–BLUE and NIR–RED bands was more sensitive for the detection of coffee leaf miner infestation; therefore, the NIR, BLUE, and RED bands were selected to develop the new index. The “Coffee-Leaf-Miner Index” presented the best performance among those evaluated, with a coefficient of determination of about 0.87, a root mean square error of 4.92% coffee leaf miner infestation, accuracy of 89.47%, and kappa coefficient of 95.39. The R2 range of other spectral indices which exist in the literature and which were used in this study was from 0.017 to 0.867, and the root mean square error ranged from 4.996 to 13.582% coffee leaf miner infestation. The machine learning method was then adopted using the supervised Random Forest and Support Vector Machine algorithms to recognize patterns of coffee leaf miner infestation in the field, only the Coffee-Leaf-Miner Index was used for the identification test of the coffee leaf miner infestation. The Support Vector Machine with linear Kernel type was applied to establish a discrimination model. The number of trees for the Random Forest classifier was 100. The Support Vector Machine presented a lower performance than the Random Forest algorithm, but the performance of both were above 80% for user and producer precision. Three bands (Blue, Red, NIR) were selected for the creation of the new index, which showed capacity for remote detection of coffee leaf miner infestation on a regional scale. Thus, “Coffee-Leaf-Miner Index” can identify coffee leaf miner infestation thanks to all the complexity involved in detecting pests via orbital remote sensing.

Introduction: Cholangiocarcinoma (CCA) includes a heterogeneous group of biliary cancers with dismal prognosis and increasing incidence. Information on epidemiology and risk factors are scarce, particularly in Latin America. Aim: Describe and analyze a multicentric cohort of CCA patients from Latin America. Methods: The Ibero-Latin American Research Network on Cholangiocarcinoma (ILARN-CCA) Registry and ESCALON consortium (www.escalon.eu) collected data from patients diagnosed from 2010 and onwards. Results: 183 patients with histologically/cytologically confirmed CCA were included from 5 tertiary hospitals (Brazil,Argentina,Chile,Ecuador and Peru). Median age at diagnosis was 62 years-old (IQR:25-87) and 55.7% were women. Most frequent risk factors were overweight/obesity (n=68;31.1%), diabetes (n=35;19.1%), NAFLD (n=14;7.7%), viral hepatitis (n=5;2.7%), cirrhosis (n=4;2.2%), gallstones (n=10;5.5%), primary sclerosing cholangitis (n=11;6%) and 21.3%(n=39) had no known-risk factor. Intrahepatic CCA was the predominant type (n=73;39.9%), followed by distal (n=49;26.8%) and perihilar (n=38;20.8%). Regional lymph-node invasion was found in 74 (40.4%) and metastasis in 79 (43.2%) patients. Upon diagnosis, 88 patients (48.1%) required upfront biliary stenting prior to main treatments, consisting in resection (n=39;21.3%) or palliative modalities (n=135;73.8%). Recurrence occurred in 64.1%(n=25), with median time-to-recurrence of 13.5 months (95%CI:6.5-18.8). Chemotherapy was delivered to 120 patients (Gemcitabine+Cisplatin:n=105;87.5%) with a median progression-free survival of 4.2 months (95%CI:3.4-4.9). Median overall survival of the entire cohort was 8.2 months (n=183;95%CI:6.3-10.2), 22.5 (n=39;95%CI:11.6-34.1) under surgery, 10.4 (n=87;95%CI:8.4-13.6) under chemotherapy and 2.5 (n=30;95%CI:1.5-3.9) without active treatments (log-rank p

Introduction: Non-Alcoholic Fatty Liver Disease (NAFLD) covers a wide spectrum of disease, ranging from simple steatosis to cirrhosis. Liver biopsy is still the gold standard for assessing fibrosis, but there is a need to seek non-invasive biomarkers that can also be efficient in predicting fibrosis. Objectives: To evaluate the role of microRNAs miR-21, miR-29a, miR-122, miR-155 and miR-181a in the phenotypic expression of NAFLD, correlating their serum levels with the different stages of the disease. Methods: Cross-sectional study carried out on 108 NAFLD patients diagnosed by liver biopsy. In the histological analysis, the degrees of fibrosis and NAFLD activity score (NAS) were obtained. The FIB-4 and NAFLD fibrosis score were calculated and compared with the degree of fibrosis by biopsy. The comparison between the distributions of microRNA values ​​according to the presence or absence of clinically expressed fibrosis (F2-4) was performed. The serum expression of microRNAs was also compared with the NAS of the biopsy. A multivariate logistic regression analysis was performed to build a score for predicting fibrosis using FIB-4 and Ln (miR-181a) as independent variables. Results: Among the microRNAs studied, only miR-181a showed a statistical difference between patients with clinically expressed fibrosis and those without fibrosis (F0-F1) determined by liver biopsy (p = 0.017). FIB-4 revealed an AUC on the ROC curve of 0.667 to predict clinically expressed fibrosis (F2-F4). When assessed using the score in association with Ln (miR-181a), there was an improvement in the ROC curve, with AUC of 0.71. There was no correlation between the serum levels of microRNAs miR-21, miR-29a, miR-122, miR-155 and miR-181a with the degrees of inflammatory activity determined by NAS. Conclusion: miR-181a can be used as a non-invasive method of predicting fibrosis in NAFLD, and an association of biomarkers has the potential to increase the accuracy of each method alone.

The Angolan Government intends to recover its 1970s expressive production of coffee by means of agricultural financing programs, mainly directed to family farmers. This study aimed to perform the agroclimatic zoning for the coffee crop in the Angolan territory. Data or estimates of annual temperature, effective and total rainfall rates, climatic water balance and annual water deficit were evaluated for all the 163 Angolan municipalities. The effective and total precipitation data were used for the agroclimatic zoning of the coffee crop in the country. Based on the effective precipitation data, 1 %, 20 % and 79 % of the Angolan territory were respectively considered suitable, marginal and unsuitable for the Arabica coffee, while, for the Robusta coffee, the same rates were, respectively, 1 %, 8 % and 91 %. Based on the total precipitation data, these rates were 2 %, 27.5 % and 70.5 % for the Arabica coffee and 1 %, 11.8 % and 87.2 % for the Robusta coffee. The areas considered marginal and unsuitable for the coffee crop in Angola are related to water deficit conditions, mainly in the southwestern region and along the coastal strip. The results obtained from the climatic water balance show that most part of the Angolan territory is marginal or unsuitable for the coffee crop.

Anisakiasis is an emerging marine food-borne zoonosis resulting from the accidental ingestion of Anisakis larvae, through the consumption of raw or undercooked infected seafood products. The first case of human gastric hyperinfection by Anisakis simplex with an unusual and severe presentation, occurring in a Portuguese woman, is described in this article. Over 140 anisakid larvae were removed by gastroscopy. Massive infection is uncommon in areas where the consumption of raw fish is not part of the traditional diet, as is the case in Portugal. The increased consumption of raw seafood products is considered a health determinant in the rise in cases of anisakiasis. However, clinicians should be aware of the emergence of these infections, not only because of the new dietary habits of the population, but also because of the high prevalence of Anisakis larvae in the different fish species usually consumed by the population, collected on the Portuguese coast. Keywords: Anisakiasis, Foodborne disease, Fishery products, Emergent zoonosis

This paper summarizes the proceedings of the joint European Surgical Association ESA/American Surgical Association symposium on Surgical Education that took place in Bordeaux, France, as part of the celebrations for 30 years of ESA scientific meetings. Three presentations on the use of quantitative metrics to understand technical decisions, coaching during training and beyond, and entrustable professional activities were presented by American Surgical Association members and discussed by ESA members in a symposium attended by members of both associations. [ABSTRACT FROM AUTHOR]

We report a case of a 50-year-old woman who presented to the emergency department with large bowel obstruction and anemia. The initial imaging study suggested an inoperable rectal tumor with involvement of surrounding structures. In this paper, we discuss the diagnostic work-up of this patient with a diagnosis of pelvic/perirectal inflammatory myofibroblastic tumor (IMT). IMT is a rare tumor with intermediate malignant potential that frequently mimics clinical and imaging features of malignancy. Additionally, to the best of our knowledge, this is the first case of a pelvic IMT that regressed without surgical excision.

INTRODUCTION: The consensus about the relationship between TMD and orthodontic treatment has gone from a cause and effect association between TMD and orthodontic treatment to the idea that there is no reliable evidence supporting this statement. OBJECTIVE: To assess the beliefs, despite scientific evidence, of Brazilian orthodontists about the relationship between TMD and orthodontic treatment with regards to treatment, prevention and etiology of TMD. METHODS: A survey about the relationship between TMD and orthodontic treatment was prepared and sent to Brazilian orthodontists by e-mail and social networks. Answers were treated by means of descriptive statistics and strong associations between variables were assessed by qui-square test. RESULTS: The majority of orthodontists believe that orthodontic treatment not only is not the best treatment option for TMD, but also is not able to prevent TMD. Nevertheless, the majority of orthodontists believe that orthodontic treatment can cause TMD symptoms. CONCLUSION: This study suggests that orthodontists' beliefs about the relationship between orthodontic treatment and TMD are in accordance with scientific evidence only when referring to treatment and prevention of TMD. The majority of orthodontists believe that, despite scientific evidence, orthodontic treatment can cause TMD.

OBJETIVO: Foi descrever as representações sociais sobre tecnologias assistivas com profissionais de saúde das unidades básicas de saúde e centros de atendimento aos idosos. MÉTODOS: Participaram desta pesquisa 250 profissionais, sendo 33 homens e 217 mulheres; com idade entre 40 e 49 anos. Os dados foram obtidos através de entrevista com um questionário contendo o TALP e dados de identificação dos sujeitos. Para a análise dos dados de identificação, foi utilizado o programa estatístico SPSS e, para os textuais, o software Alceste: 2010. RESULTADOS: Indicaram que os participantes concebem as representações sociais do objeto pesquisado, de formas distintas, porém pode-se afirmar que as tecnologias assistivas é um fator importante para o envelhecimento, influenciando nos comportamentos desse grupo etário. CONCLUSÃO: O presente trabalho poderá ser útil no desenvolvimento de estratégias para a maior divulgação do que sejam as tecnologias assistivas e a sua utilização de maneira adequada pelos idosos.

O objetivo deste estudo foi determinar as probabilidades de ocorrência de períodos secos e chuvosos na região de Sete Lagoas, MG, a partir de uma série de 66 anos de dados diários de precipitação pluvial, visando subsidiar a definição da melhor data de semeadura do milho. Foram considerados dias secos aqueles que apresentaram precipitação inferior à evapotranspiração do milho, ETmilho. O estudo foi realizado para as fases de floração e enchimento de grãos a partir de sete datas de semeadura DS (01/10, 16/10, 31/10, 15/11, 01/12, 16/12 e 31/12). As chances de ocorrência dos períodos secos e chuvosos foram estimadas mediante o uso da cadeia de Markov. A probabilidade de ocorrência de dias secos foi sempre superior à de dias chuvosos. As maiores possibilidades de ocorrência de dias secos foram observadas entre as DS 15/11 e 31/12. A maior probabilidade de ocorrência de dias chuvosos foi registrada na DS 01/10. Considerando o ciclo médio estudado (para a fase mais crítica do milho), a combinação de menor chance de períodos secos com a de dias chuvosos indica que as melhores datas para iniciar a semeadura de sequeiro seriam as de DS 01/10 e 16/10.

In acute severe autoimmune hepatitis (AS-AIH), the early identification of predictors of non-response to corticosteroids and the optimal timing for liver transplantation (LT) remains controversial. To determine early predictors of non-response to corticosteroids and to assess the usefulness of severity scores, namely the recently developed SURFASA. Retrospective multicentre cohort study including consecutive patients admitted for AS-AIH between 2016 and 2020. Definitions- response to corticosteroids: LT-free survival at 90 days (D90); SURFASA score: -6.8 + 1.92x(D0-INR)+1.94xINR[(D3-D0)/D0]+1.64xbilirubin[(D3-D0)/D0]. We included 26 patients [median age 56 (45–69) years; 22 (84.6%) women]. All patients underwent corticosteroid therapy. Overall survival reached 73%. amongst the non-responders, 2 (7.8%) underwent LT and 5 (19.2%) died. The interval between admission and initiation of corticosteroids was not different between responders and non- responders [13 (7–23) vs. 8 (3–10), P:0.06], respectively. SURFASA and MELD-Na+ (D3) scores showed an AUROC of 0.96 (0.87–1) and 0.92 (0.82–0.99), respectively, for prediction of non-response. SURFASA >-2.5 had a sensitivity of 85.7% and a specificity of 100% and MELD-Na+ (D3) >26 had sensitivity of 85.7% and a specificity of 78% for the prediction of non-response. SURFASA and MELD-Na+ at D3 scores are useful in early identification of non-responders to corticosteroids. [ABSTRACT FROM AUTHOR]

Objective: To propose a new decision algorithm combining biomarkers measured in a tumor biopsy with clinical variables, to predict recurrence after liver transplantation (LT). Background: Liver cancer is one of the most frequent causes of cancer-related mortality. LT is the best treatment for hepatocellular carcinoma (HCC) patients but the scarcity of organs makes patient selection a critical step. In addition, clinical criteria widely applied in patient eligibility decisions miss potentially curable patients while selecting patients that relapse after transplantation. Methods: A literature systematic review singled out candidate biomarkers whose RNA levels were assessed by quantitative PCR in tumor tissue from 138 HCC patients submitted to LT (>5 years follow up, 32% beyond Milan criteria). The resulting 4 gene signature was combined with clinical variables to develop a decision algorithm using machine learning approaches. The method was named HepatoPredict. Results: HepatoPredict identifies 99% disease-free patients (>5 year) from a retrospective cohort, including many outside clinical criteria (16%–24%), thus reducing the false negative rate. This increased sensitivity is accompanied by an increased positive predictive value (88.5%–94.4%) without any loss of long-term overall survival or recurrence rates for patients deemed eligible by HepatoPredict; those deemed ineligible display marked reduction of survival and increased recurrence in the short and long term. Conclusions: HepatoPredict outperforms conventional clinical-pathologic selection criteria (Milan, UCSF), providing superior prognostic information. Accurately identifying which patients most likely benefit from LT enables an objective stratification of waiting lists and information-based allocation of optimal versus suboptimal organs. [ABSTRACT FROM AUTHOR]